<!--personal details starts-->
    <div class="personal_details">
        <!--scroll container starts-->  
            <div id="description">
                <!--form starts-->
                        <?php echo form_open(base_url().BASE.'join_as_submit_detail_continue', array('id' => 'join_as_form_detail', 'autocomplete' => 'off')); ?>
                        <div class="form_fields">
                            <div class="textfield_box">
                             <input autocomplete="off" type="email" name="email" onBlur="this.value=jQuery.trim(this.value)" value="<?php if(isset($input_data['email']))echo strip_tags($input_data['email']); ?>" placeholder="Email" id="email" class="detailed_textfield2 content_pink"> 
                             </div>
                             <div class="textfield_box">
                             <input autocomplete="off" type="password" id="password" onBlur="this.value=jQuery.trim(this.value)" value="<?php //if(isset($input_data['password']))echo strip_tags($input_data['password']); ?>" name="password" placeholder="Password" class="detailed_textfield2 content_blue">
                             </div>
                             <div class="textfield_box">
                                <input autocomplete="off" type="text" name="first_name" onBlur="this.value=jQuery.trim(this.value)"  value="<?php if(isset($input_data['first_name'])){ echo strip_tags($input_data['first_name']);} ?>" placeholder="First name" id="first_name" class="detailed_textfield4 content_pink"> 
                             <input autocomplete="off" type="text" id="last_name" onBlur="this.value=jQuery.trim(this.value)" value="<?php if(isset($input_data['last_name'])){ echo strip_tags($input_data['last_name']);} ?>" name="last_name" placeholder="Last name" class="detailed_textfield4 content_blue">
                            </div>
                            <div class="textfield_box">
                                <textarea autocomplete="off" name="tagline" onBlur="this.value=jQuery.trim(this.value)" placeholder="Tagline" class="content_blue detailed_textfield2"><?php if(isset($input_data['tagline']))echo strip_tags(trim($input_data['tagline'])); ?></textarea>
                            </div>
                            <div class="clear"></div>
                            <div class="clear"></div>
                            
                            <div class="textfield_box">
                                <textarea autocomplete="off" name="alias" onBlur="this.value=jQuery.trim(this.value)" id="alias" placeholder="Alias" class="detailed_textfield2 content_pink"><?php if(isset($input_data['alias']))echo strip_tags(trim($input_data['alias'])); ?></textarea>
                            </div>
                            <div class="clear"></div>
                            
                            <div class="textfield_box">
                                <input autocomplete="off" type="text" onBlur="this.value=jQuery.trim(this.value)" name="dob" id="dob" value="<?php if(isset($input_data['dob']))echo strip_tags($input_data['dob']); ?>" placeholder="Date of Birth (dd/mm/yyyy)" class="detailed_textfield2 content_blue">
                            </div>
                            <div class="clear"></div>
                            
                            <div class="textfield_box">
                                <div class="country_form country_name detailed_textfield content_pink">
                                    <?php if(isset($input_data['country']) && $input_data['country']!='')echo strip_tags($input_data['country_1']);else echo 'Country'; ?>
                                </div>
                            </div>
                            <div class="clear"></div>
                             
                            <div class="textfield_box">
                                <textarea autocomplete="off" name="home_address" id="home_address" onBlur="this.value=jQuery.trim(this.value)"  placeholder="Home Address" class="detailed_textfield2 content_pink"><?php if(isset($input_data['home_address']))echo strip_tags(trim($input_data['home_address'])); ?></textarea>
                            </div>
                            <div class="clear"></div>
                            
                            <div class="textfield_box">
                                <div class="state_form detailed_textfield content_pink">
                                    <?php if(isset($input_data['state']) && $input_data['state']!='')  echo strip_tags($input_data['state']); else echo 'State'; ?>
                                </div>
                                <div class="city_form detailed_textfield content_blue">
                                    <?php if(isset($input_data['city']) && $input_data['city']!='') echo strip_tags($input_data['city']);else echo 'City'; ?>
                                </div>
                                <!--<input type="text" name="city" id="city" value="" readonly placeholder="City" class="detailed_textfield content_pink">
                                <input type="text" name="state" id="state" value="" readonly placeholder="State" class="detailed_textfield content_blue">-->
                                <input autocomplete="off" type="text" name="postal_code" onBlur="this.value=jQuery.trim(this.value)" id="postal_code" value="<?php if(isset($input_data['postal_code']))echo strip_tags($input_data['postal_code']); ?>" placeholder="Postal Code" class="detailed_textfield content_pink">
                                <div class="clear"></div>
                            </div>
                            <div class="clear"></div>
                            <div class="textfield_box">
                                <input autocomplete="off" type="text" name="phone_number1" onBlur="this.value=jQuery.trim(this.value)" id="phone_number1" value="<?php if(isset($input_data['phone_number1']))echo strip_tags($input_data['phone_number1']); ?>" placeholder="Phone Number 1" class="detailed_textfield2 content_blue">
                            </div>
                            <div class="clear"></div>
                            <div class="textfield_box">
                                <input autocomplete="off" type="text" name="phone_number2" onBlur="this.value=jQuery.trim(this.value)" id="phone_number2" value="<?php if(isset($input_data['phone_number2']))echo strip_tags($input_data['phone_number2']); ?>" placeholder="Phone Number 2" class="detailed_textfield2 content_blue">
                            </div>
                            <div class="clear"></div>
                            <div class="textfield_box">
                                <input autocomplete="off"  type="text" name="phone_number3" onBlur="this.value=jQuery.trim(this.value)" id="phone_number3" value="<?php if(isset($input_data['phone_number3']))echo strip_tags($input_data['phone_number3']); ?>" placeholder="Phone Number 3" class="detailed_textfield2 content_blue">
                            </div>
                            <div class="clear"></div>
                            
                            <div class="submit_button">
                                <input autocomplete="off"  type="button" value=""  name="personal_detail" id="personal_detail">
                            </div>
                        </div>
                        
                        <!--select class starts-->
                        <div class="select_countryform">
                            <div class="go_back">
                            <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input  type="text" id="country" maxlength="100" name="country" placeholder="Country" value="<?php if(isset($input_data['country']))echo strip_tags($input_data['country']); ?>" class="textfield content_blue blue" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located1']; ?>
                            <input type="hidden" id="country_1" name="country_1" value="<?php if(isset($input_data['country_1']))echo strip_tags($input_data['country_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="country_result">
                            </div>
						</div>
                    <!--slelect class closed-->
                        <!--select school starts-->
                        <div class="select_stateform">
                            <div class="go_back">
                                <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="state" maxlength="100" name="state" placeholder="State" value="<?php if(isset($input_data['state']))echo strip_tags($input_data['state']); ?>" class="textfield content_pink pink" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located1']; ?>
                            <input type="hidden" id="state_1" name="state_1" value="<?php if(isset($input_data['state_1']))echo strip_tags($input_data['state_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="state_result">
                            </div>
	                  </div>
					<!--select shcool closed-->
                    <!--select class starts-->
                        <div class="select_cityform">
                            <div class="go_back">
                            <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" onBlur="this.value=jQuery.trim(this.value)" id="city" maxlength="100" name="city" placeholder="City" value="<?php if(isset($input_data['city']))echo strip_tags($input_data['city']); ?>" class="textfield content_blue blue" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located1']; ?>
                            <input type="hidden"  id="city_1" name="city_1" value="<?php if(isset($input_data['city_1']))echo $input_data['city_1']; ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="city_result">
                            </div>
						</div>
                    <!--slelect class closed-->
                    <input type="hidden" name="member_type" id="member_type" value="<?php if(isset($member_type)){ echo strip_tags($member_type);} ?>"  />
                    <input type="hidden" name="part" id="part" value="personal"  />
             <?php echo form_close(); ?>                                                            
             <!--form closed-->
            </div>
<!--scroll container starts-->
</div>